Vaccine Trifecta - Provider Newsletter October, 2023

Blue Cross^® Blue Shield^® of Arizona (AZ Blue) encourages members to take advantage of vaccine protection. This season, we can help prevent serious disease from RSV, COVID-19, and influenza. Here’s what you need to know about our vaccine coverage and cost share for most of our commercial plans.

RSV vaccines

Good news! For commercial claims, we now cover RSV vaccines under both pharmacy and medical benefits for adults ages 60 and older at $0 cost share. Abrysvo™ is covered for pregnant women under both pharmacy and medical benefits (a pregnancy qualifier code is required on pharmacy claims). The infant RSV vaccines are covered only under the medical benefit.

For Medicare Advantage plans, the vaccines are covered under Part D at $0 cost share, following the clinical recommendations of the CDC Advisory Committee on Immunization Practices (ACIP).
For Federal Employee Program^® (FEP^®) plans, we will follow FEP guidelines.

Here is a high-level summary of our current coverage for the newly approved RSV vaccines.

Note: The Synagis^® (palivizumab) vaccine is covered only under the medical benefit (at the preventive-level cost share) and requires prior authorization.

COVID-19 vaccines

The updated COVID-19 vaccines are all covered under both pharmacy and medical benefits at $0 cost share. This includes the new Comirnaty^® and Spikevax^® boosters. Our coverage aligns with the age-group guidelines from the FDA prescribing information.

Flu shots

This is the perfect time to recommend flu shots. These are also covered under both pharmacy and medical benefits at $0 cost share.

In This Issue

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October news: Executive summary

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Prosano benefit plans for employer groups for 2024

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RSV, COVID-19, and influenza vaccine coverage

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Changes to Part B Step Therapy program

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Take the #StigmaFreeAZ pledge and spread the word

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Be sure to ask, "When was your last mammogram?"

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CMS: Notifying MA enrollees of provider terminations

Get an update on the AZ 988
Crisis Response Performance

CPT (Current Procedural Terminology) codes and modifiers are ©2023 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Arexvy is a trademark of GSK.

Abrysvo is a trademark of Pfizer Inc.

Beyfortus is a trademark of Sanofi.

Synagis is a registered trademark of Arexis AB c/o Swedish Orphan Biovitrum AV (publ).

Comirnaty is a registered trademark of BioNTech SE and Pfizer Inc.

Spikevax is a registered trademark of ModernaTX, Inc.

Blue Cross, Blue Shield, the Cross and Shield Symbols, MyBlue, BlueCard, Federal Employee Program, and FEP are registered service marks, and BluePathway and BlueJourney are service marks, of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

© 2023 Blue Cross Blue Shield of Arizona, Inc. All rights reserved.

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